KOSTROMA, Russia — Yuri Frolov, 24, started using heroin when he was 16 and living in the city of Kostroma, north of Moscow.

Kostroma isn’t known for heroin. The city of almost 300,000 is on Russia’s Golden Ring, a collection of picturesque cities northeast of Moscow visited by tourists for their typical Russian architecture and onion-shaped church domes.

My wife and I met Frolov in May at a drug rehabilitation center in the countryside in southern Russia, near the city of Stavropol. The center is austere. There is no running water and residents have to use outhouses. It’s part work camp, part monastery. The ascetic lifestyle and fresh air are thought to help addicts give up their dependencies. But this bucolic patch of land in the rolling hills of the northern Caucasus comes as a shock for many of the young addicts, who are used to cell phones and urban apartment blocks.

Before he came to the center, Frolov had never worked with livestock. Here he is in charge of collecting water from a nearby reservoir via horse-drawn carriage. In his free time he works with the center’s horses in a sprawling field.

Frolov had been clean for five months when we met. He is broad-shouldered and tall. But there is something delicate about his long face and green eyes.

Sitting on a concrete slab near the stables, Frolov spoke of how easy it was for him to purchase heroin back in Kostroma:

“There was a Gypsy village only three miles from the town I’m from. You’d go there. There’d be cops standing outside. You’d pay them 100 rubles ($3.60) to get in and 50 rubles to get out. The gypsies would yell at you, ‘Buy from me. I’ve got the best stuff.’ You didn’t need to look or anything. There was good quality heroin everywhere.”

Since 2001, the year American and Canadian troops entered Afghanistan, heroin production has reached record levels. And a significant amount of that heroin is ending up here, in Russia. According to the United Nations Office on Drugs and Crime, it is the world’s largest national market for heroin, consuming about 20 percent of all the heroin trafficked from Afghanistan annually.

There are at least 1.5 million heroin users in Russia. It’s estimated that every day 80 people die from heroin addiction.

At a press conference in May, the head of Russia’s anti-drug agency, Viktor Ivanov, told reporters that among Russia’s most important goals is the liquidation of global drug crimes at the highest levels. It’s no secret that he was referring to Afghan heroin. A map detailing the global heroin trade from Afghanistan to the world was projected on a screen behind him.

“A million people have died globally from Afghan heroin over the past 10 years,” the stern-faced, former KGB officer said.

According to Russia’s Federal Drug Control Services (FSKN), the FSKN and the U.S. military have carried out five joint operations in Afghanistan to destroy drug labs. Russia’s involvement raised the ire of Afghan President Hamid Karzai, as any presence of Russian forces remains a sensitive issue for Afghanis who remember the war with the Soviets.

Despite its focus on the issue, Russia can’t seem to stop the flow of cheap heroin across its borders from the central Asian countries of Uzbekistan, Tajikistan, Kazakhstan, Kyrgyzstan and Turkmenistan.

Since the collapse of the Soviet Union, travel from these former Soviet Republics into Russia has remained visa-free. It hasn’t helped that Russian border guards were removed from Tajikistan — which shares an 835-mile border with Afghanistan — in the summer of 2005. Government corruption has also fueled heroin traffic across central Asia and into Russia.

“Heroin defiles and corrupts everything,” said Yuri Krupnov, director of the Institute for Demography, Migration and Regional Development in Moscow. “It is such a powerful geo-economic, geo-political force, with anonymous authors, that it is impossible to confront it.”

That explains why heroin is still ending up in the veins of young people like Frolov and another addict at the rehab center, Alexei Vanchikov.

"I can count the people who I started using drugs with who are still alive on one hand," Vanchikov said. He has lived for five years with HIV and refuses to take medication.

Here at the Spaso Preobrazhenski Rehabilitation Center, rehabilitation consists of manual labor and prayer. The center is run in association with the Russian Orthodox Church and is completely free for addicts. The brain behind this type of open-air rehabilitation is Nikolai Novopashin, a former addict and an evangelist for recovering drug users.

On a recent afternoon at the center, Novopashin spoke to nearly 30 recovering addicts seated outside on benches. "There are businessmen and doctors who think you should all be rounded up and drowned at sea,” he bellowed. Novopashin doesn’t mince his words.

And he’s right. Despite the tough talk of Russian officials, such as FSKN’s Ivanov, rehabilitation has in many ways been an afterthought of Russia’s drug strategy.

Novopashin's way may not necessarily be the best method. Drug policy experts and advocates both within Russia and internationally have criticized Russia for its abstinence-based approach to drug rehab.

Writing on OpenDemocracy.net in May 2011, former heroin addict and drug rights activist Irina Teplinskaya said, "Russia’s official approach to the treatment of drug addiction is based on forced abstinence. It both humiliates drug users and deprives them of their rights.”

In October 2010, Yegor Bychkov, head of the City Without Drugs Foundation in the Russian city of Nizhny Tagil, was sentenced to three and a half years in jail for kidnapping a young drug addict. But just a few months later, the charges were reduced and Bychkov was released.

It's clear from this case that public opinion around drug abuse is very complicated.

In Moscow, a group known as Duri Net outs drugs dealers by pouring indelible ink on them. In Yekaterinburg, another branch of City Without Drugs targets Gypsy families who are thought to be involved in the drug trade.

With the government unable — or unwilling — to address a problem as serious as heroin addiction, to many there is only one solution left: dealing with it on their own.

But Novopashin said neither drug addicts nor small-time dealers are to blame:

"We should blame the people who didn’t give them a good reason to live, who didn’t give them a sense of purpose, a sense of patriotism, a sense of national identity. Then we should blame the people who made all this possible — you think heroin just falls out of the sky!?"

Ilnur Batyrshin is a research specialist for AntiDrugFront.ru, a think tank that tracks the heroin trade from Afghanistan, through central Asia and into Russia.

In a recent interview, Batyrshin told CCIR, "The heroin problem is a direct result of opium production in Afghanistan and whether we want it or not, so long as Afghanistan keeps producing opium we’ll continue to have a heroin problem. The only way to stop that is to put a stop to opium production in Afghanistan."

Other addicts we spoke to confirmed that after the American invasion of Afghanistan in 2001, there was a "wave" of heroin flowing into Russia.

According to Yuri Krupnov, there is direct correlation between the amount of heroin in production and the number of troops in Afghanistan. “As one increases,” he said, “so does the other.”

Russia would like to nip heroin production in the bud by destroying poppy fields in Afghanistan. But Canada and other NATO countries have refused to do so, saying that it is outside of their purview.

Russia's tiniest drug capital

A few hours from Moscow by train is the town of Kimry. It was once a town of shoemakers. In the Soviet Union, residents worked in local shoe and textile factories. But in 2001, it was flooded with heroin.

By 2004, the problem was impossible to ignore. Father Andrei Lazerov became an outspoken advocate for young addicts in Kimry.

The Russian orthodox priest has a long flowing beard, hair pulled back into a knot behind his head, and wears a massive gold cross over his black robes. On a recent afternoon at his home in Kimry, he remembered what the town was like not long ago.

"We had around 300 drug dealers and 311 students in the city,” he said, almost in a whisper. “There were needles everywhere. From this house where we are right now, they sold drugs 200 meters (218 yards) that way, 300 meters in that direction they were selling heroin, and over there too.”

Kimry became known as Russia's tiniest drug capital. According to Lazerov, the local drug mafia was protected by the local prosecutor at the time. A kilo, or two pounds, of heroin was sold every day in Kimry. According to a 2004 news report on Russian state TV, nearly one in five residents in this city of 50,000 was addicted to drugs.

With all of the attention Kimry received in the Russian press, the city was eventually cleaned up and the problem was no longer visible when we visited. Still, in the area near the train station where heroin was once sold openly we found ample evidence of recent heroin use: Needles littered the dirt road and local residents told us that drugs are still sold there.

At the rehab center near Stavropol, we met up with Dmitry Glazunov, a former addict from Kimry. Glazunov is soft-spoken and very polite.

"All of the people I know who are around my age shoot up heroin," he said. "As for the older guys I started shooting up with, there are only two or three left. And they have HIV and they might already be dead. If you go to the cemetery in Kimry you’ll notice that there aren’t very many old people — it’s all kids."

Glazunov said that he's afraid to return to Kimry because he knows the temptation to use again is too great.

“I’ll walk through the area where they sell drugs right near the train station,” he said. “Even if I can hold off for two or three days, it’ll draw me in eventually."

Rehabilitation strategy?

The FSKN’s Viktor Ivanov is kept busy by Russia’s Afghan heroin addiction. In May, he visited the Spaso Preobrazhenski Rehabilitation Center while we were there.

It was a whirlwind event. He swept in with his entourage in a shiny black Land Rover and was greeted by the local patriarch of the Russian Orthodox Church. During his 45-minute visit he was whisked around the grounds by Novopashin, performing a sped-up version of the stations of the cross.

Former addicts stood waiting at the positions Novopashin had assigned them: in the wood working shop, near the rabbit pens, beside a chirping clutch of ducklings. Yuri Frolov stood beside a saddled horse. When Ivanov passed by, Novopashin told Frolov to get up and ride. There were oohs and ahhs from the crowd. Novopashin had turned an urban heroin addict into a Russian version of John Wayne.

After Ivanov's visit, Novopashin's center received government "certification.” That means it will receive about 10,000 rubles ($350) each month per recovering addict. It also means the Russian government can say they are doing something to fund rehabilitation.

But according to Pavel Aksenov, executive director of the Russian Harm Reduction Network (ESVERO) in Moscow, the government’s strategy to bolster drug rehab is putting the cart before the horse.

“A certification program isn’t going to solve the problem,” he said on a recent morning in his office in downtown Moscow. “First you have to focus on creating an effective system of social rehabilitation.”

According to Aksenov, such a system does not yet exist in Russia. For the most part, state-sponsored rehabilitation is a quick affair. It involves cleaning an addict’s blood and putting him back on the street again. Rehabilitation requires time. Add to that the fact that methadone treatment, used to reduce opium dependency, is illegal in Russia.

Moreover, there is no system of quality control in Russia to determine the effectiveness of the nearly 400 private drug rehabilitation centers that exist here.

Aksenov says that in United States, and closer to home in Belarus and Ukraine, rehabilitation centers use what is known as an Addiction Severity Index to determine the effectiveness of an addict’s rehabilitation.

Recovering addicts are judged on whether they are taking medication for diseases like HIV (remember 33-year-old Alexei Vanchikov), or whether they have gone back to school or have managed to hold down a job.

At Novopashin’s center, recovery is a matter of faith. And there are no formal means for determining how effective his methods are. At least six addicts we met there had left, relapsed and returned.

According to Human Rights Watch, state-run rehabilitation centers exist in only 26 of Russia’s 85 regions. CCIR could only identify four free state-run rehabilitation centers in the country.

Relapse

In June, Yuri Frolov returned home to Kostroma for his mother's birthday.

Vadim Hachaturov, a former heroin addict who manages the rehab center near Stravropol, warned Yuri that it was too soon to go home. The risk of falling into old habits was too great, Hachaturov said.

But Frolov left anyway.

We met up with Frolov in Moscow on his way to Kostroma in June. We walked along the Moscow River on a sunny afternoon. Frolov was happy to be going home, to see his mom, to spread his wings after spending almost half a year in rehab. He also spoke openly about his fear of using again. He said he might travel with his mother to a nearby lake for a vacation, away from the temptations of his friends and former acquaintances who are still using.

We said goodbye in front of the metro station, and as we turned to walk away, my wife told me she had a bad feeling that Frolov was going to start using again.

In the weeks that followed our brief visit, we tried to call, but were unable to reach Frolov. Finally, we called Hachaturov in Stravropol. He told us that Frolov had started shooting up again. His mother had called the center in tears, asking him what she should do. Hachaturov was furious, thinking that Frolov had gone and proved him right.